Provider Demographics
NPI:1699177881
Name:FONTAINE, SHERYLIN
Entity Type:Individual
Prefix:
First Name:SHERYLIN
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 UNION STREET
Mailing Address - Street 2:G02
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608
Mailing Address - Country:US
Mailing Address - Phone:508-756-2005
Mailing Address - Fax:
Practice Address - Street 1:51 UNION ST
Practice Address - Street 2:G02
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1194
Practice Address - Country:US
Practice Address - Phone:508-756-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health